OBJECTIVES To examine the relationships between changes from baseline to post-Resources for Enhancing Alzheimer's Caregiver Health (REACH) intervention in caregiver (CG) self-reported health, burden, and bother. DESIGN Randomized, multisite clinical trial. SETTING CG and care recipient (CR) homes in five U.S. cities. PARTICIPANTS Four hundred ninety-five dementia CG and CR dyads (169 Hispanic, 160 white, and 166 African American) receiving intervention and their controls. INTERVENTION CGs were assigned to the REACH intervention or a no-treatment control group. Intervention subjects received individual risk profiles and the REACH intervention through nine in-home and three telephone sessions over 6 months. Control subjects received two brief “check-in” telephone calls during this 6-month period. MEASUREMENTS The primary outcome was change in CG health status from baseline to after the intervention. Secondary outcomes were CG burden and bother after the intervention. RESULTS After the intervention, CGs reported better self-rated health, sleep quality, physical health, and emotional health, which was related to less burden and bother with their caregiving role than for CGs not receiving the intervention. Changes in depression appeared to mediate these relationships. Several racial and ethnic group differences existed in physical and emotional health, as well as in total frustration with caregiving, emotional burden, and CG-rated bother with CR's activities of daily living and instrumental activities of daily living at baseline and at follow-up, although differences between baseline and posttest did not vary according to race. CONCLUSION A structured, multicomponent skills training intervention that targeted CG self-care behaviors as one of five target areas, improved self-reported health status, and decreased burden and bother in racially and ethnically diverse CGs of people with dementia.

Purpose To assess vision health disparities in the United States by race/ethnicity, education, and economic status. Design Cross-sectional, nationally representative samples Methods We used national survey data from the National Health and Nutrition Examination Survey (NHANES) and the National Health Interview Survey (NHIS). Main outcome measures included, from NHANES, age-related eye diseases (i.e., age-related macular degeneration [AMD], cataract, diabetic retinopathy [DR], glaucoma) and from NHIS, eye care use (i.e., eye doctor visits and cannot afford eyeglasses when needed) among those with self-reported visual impairment. The estimates were age- and sex-standardized to the 2000 US census population. Linear trends in the estimates were assessed by weighted least squares regression. Results Non-Hispanic whites had a higher prevalence of AMD and cataract surgery than non-Hispanic blacks, but a lower prevalence of DR and glaucoma (all P < 0.001 in NHANES 2005–2008). From 1999 to 2008, individuals with less education (i.e., < high school vs. > high school) and lower income (poverty income ratio [PIR] < 1.00 vs. ≥4.00) were consistently less likely to have had an eye care visit in the past 12 months compared with their counterparts (all P < 0.05). During this period, inability to afford needed eyeglasses increased among non-Hispanic whites and Hispanics (trend P = 0.004 and P = 0.007; respectively), those with high school education (trend P = 0.036), and those with PIR 1.00–1.99 (trend P < 0.001). Conclusions Observed vision health disparities suggest a need for educational and innovative interventions among socioeconomically disadvantaged groups.

OBJECTIVES-To investigate the relationship between self-report and behavioral indicators of pain in cognitively impaired and intact older adults. DESIGN-Quasi-experimental, correlational study of older adults.SETTING-Data were collected from residents of nursing homes, assisted living, and retirement apartments in North/Central Florida. PARTICIPANTS-126 adults, mean age 83 years; 92 cognitively intact, 24 cognitively impaired.MEASUREMENTS-Pain interviews (pain presence, intensity, locations, duration), pain behavior measure, MMSE, analgesic medications, and demographic characteristics. Participants completed an activity-based protocol to exacerbate pain. RESULTS-86%self-reported regular pain. Controlling for analgesics, cognitively impaired participants reported less pain after movement, but not at rest. Behavioral pain indicators did not differ between cognitively intact and impaired elders. Total number of pain behaviors was significantly related to self-reported pain intensity (Beta = .40, p = .000) in intact elders. CONCLUSION-Self-reported pain is diminished in cognitively impaired elders relative to intact elders, independent of analgesics, but only when assessed following movement. Behavioral pain indicators do not differ between groups. The relationship between self-report and pain behaviors supports the validity of behavioral assessments in this population. Findings support multidimensional pain assessment in persons with dementia.

No abstract

No abstract

No abstract

Previous research has indicated that homeless children exhibit high rates of behavioral and emotional problems and come from families characterised by conflict and rejection. Further, some evidence exists to show that family variables may relate to adolescent distress differently for homeless males and females. In this study, 117 homeless adolescents were compared to a sample of non-homeless youths on the self reported incidence of personal and family problems. The homeless children reported the highest incidence of all behavioral and emotional problems, parental marital discord, overprotection, and the lowest levels of parental care and acceptance. Sex effects were not evident in reported levels of personal or family problems. However, substantially more variance in the adolescents level of behavioral and emotional disturbance was predictable from family measures for females than males. Overall, the results point to the importance of incorporating family distress models in the understanding and remediation of adolescent homelessness.

No abstract